Caring For Our Future by Forgetting Advocacy?

I’ve just taken a quick look at  “Caring for our future: reforming care and support” and it seems to signal an end to the phrase “information, advice and advocacy”. Information? Yes. Advice? Yes? Advocacy?.....

Well in terms of advocacy there seems to be some misunderstanding, some rewinding of the clock, a whole lot of forgetting and a potentially risky future. Here’s the sum total of the report’s mention of advocacy.

“Advocacy services have been in place for more than 30 years, often providing support for people who lack mental capacity and who have no-one to act on their behalf. These services will continue to play a vital role in supporting people and we need to understand better the benefits of these services and how cost-effective they can be. We will therefore work with partners to develop and disseminate best practice and potential new business models”

That's it. 

Well, most advocacy is for people who have capacity. Overwhelmingly so. It’s not the lack of capacity to make a specific decision that leads people to need advocacy. Rather it’s the experience of not being listened to, not being included in decision making, being discriminated against, being abused, being in receipt of poor or inappropriate services or not being able to access services (including basic health care) at all. Those are the main triggers.  To focus on a lack of capacity risks locating the fault with the individual, not the services. 

And advocacy is not just for people who have no-one to act on their behalf. Not even the IMCA role is limited to this. Many of  carers I spoke to at the social care lobby of parliament talked about wanting an advocate for the person they looked after. And while I’m firmly behind the idea of getting a better view on the impact and effectiveness of services, I'm concerned that this single statement ignores a wealth of evidence pointing to the impact and value of advocacy. 

If that’s the case, forget all of those mentions about the importance of advocacy as a safeguard against abuse and in safeguarding processes. Forget the CQC's thematic review on learning disability services, ignore SCIE guidance on safeguarding, forget the lessons from Winterbourne view, forget the Kerr-Haslam report, forget all the other reports that make the same point. 

Ignore Valuing People, forget about the Care Quality Commission’s excellence framework. Forget about the NHS Confederation’s report Delivering Dignity. Forget the value that the Mental Capacity Act  Code of Practice puts on advocacy as a means of enabling people to be more involved in decisions about their lives (and no, that’s not a reference to IMCA). Forget EHRC's report "From safetynet to springboard". Forget the Law Commission’s report on reforming social, they were obviously having an off day when they recommended realising the right to advocacy for all disabled people. And I can only conclude that the Joint Committee on Human Rights was similarly confused when they supported the call.  Forget them both, forget them all, but remember this.

Every single time someone approaches an advocacy service, it is an indication that they believe some decisions about their life are out of their control; that something about them is being decided without them, that they are at risk or their voice is not being heard. A request for advocacy is a request for autonomy and control. It’s often a sign that the care and support system isn’t working. And, with the exception of some statutory provision, it’s a statement of belief from individual people that advocacy creates real change for them.

So when we look for the effectiveness, cost effectiveness and value of advocacy, let’s make sure we don’t choose models that ignore those problems or are incapable of offering credible solutions. And when it comes to decisions that materially impact on the lives of people who demand advocacy services, let’s live up to the statement  that the health white paper borrowed from the advocacy movement - “Nothing about me without me”.

Right answer, wrong question?

I recently got a birthday card that said “The answer is football. The question is largely irrelevant”. Someone knows me very well. When people hear organisations talk about the need for more advocacy provision they may well suspect the same kind of failing. It doesn’t matter what the question is, we’ll tell you that the answer is advocacy.

So today I spent the day with the Care in Crisis lobby of parliament and taking part in the online #twobby. I met many inspirational people, heard challenging stories from people struggling to get the right social care, met and had a good discussion with my local MP and heard Paul Burstow talk about his plans for the Social Care White Paper.  And I tried not to talk about advocacy too much, because the questions weren’t always about advocacy; they were usually about dignity, fairness, funding, appropriate services, connection to communities.  Advocacy isn’t the answer to these questions, but it is a mechanism that informs those answers.

So when we hear that people need support to navigate the new care system, that people need support speaking up, that getting appropriate care is a constant battle, that people are afraid of complaining on behalf of relatives, that closed care systems breed abuse  – well, advocacy is part of the answer. (If you don't believe me you may want to look at my previous post A Gap in Dignity and Rights.)

Paul Burstow spoke of a future where local authorities should be held to account within national frameworks of expectations. He has previously spoken of the role that advocacy plays in demonstrating that local authorities are meeting their equalities duties. Including a requirement to record the advocacy needs of a community in the Joint Strategic Needs Assessment would help local communities hold LAs to account on this; it would let us see the distance between should and is.

Then local communities would be able to check that there is at least one mechanism in place to address the real question; have we done enough to make sure that everyone's care needs will be met in a personal, appropriate and dignified way?